Martha Watson, MS, APRN, GCNS Christie Bowser, RN-BC Frailty Martha Watson, MS, APRN, GCNS Christie Bowser, RN-BC

Objectives Define the term “frailty” Identify patients who meet the criteria for frailty Identify interventions for the frail patient

Why Is This New? But I have heard this expression for a LONG time? This is a field of study that is rapidly expanding in: Publications Definitions Screening Tools Biological Understanding Clinical Utility

Why Frailty Matters

Incidence Just think about the size of the always increasing aging population… 3-7% of 65-75 year olds 20% of those >80 years old 33% of those >90%

Why Frailty Matters Up to 15% of community dwelling older adults A higher percentage of residents of assisted living communities Prevalence increases with age All will likely meet criteria if live long enough

POOR OUTCOMES! Increase incidence of falls Worsening mobility Social withdrawal Worsening ADL disability Delirium Increase hospitalizations Cognitive decline Death

What is frailty? A person must exhibit 3 out of 5 of the following: Low physical activity Muscle weakness (decreased hand grips) Slowed performance Fatigue or poor endurance Unintentional weight loss

The Downward Spiral… More likely to become disabled, hospitalized, and have more health problems Susceptible to infection Simple infections may even result in death Loss of muscle mass Inability to prepare meals increases malnutrition

Frailty Tools- Which One? No consensus on how to best measure it!!!

Goals for Frailty Interventions Improve quality of life Prevent worsening of chronic diseases Reduce risk for adverse or catastrophic outcomes Risk assessment to guide therapeutic options and goal setting

Treating Frailty Individualized (determine goals & priorities of care) Coordinate services- TEAM based care for inpatients and outpatients Treating underlying disease process Medication management (BEERS list) PT/OT - EXERCISE Nutrition Pain management Fall prevention Environmental assessment Encourage socialization Palliative Care approaches – sometimes less is better……

Prevention Manage comorbidities – DM, CHF, HTN, PVD Daily exercise Keep the mind active (i.e. crossword puzzles, reading, socializing) Treat depression Seek treatment of medical and psychiatric problems Healthy diet

Interventions Ko FC. Clin Geriatr Med 2011 Feb;27(1):89-100.

On-Line Resources http://www.frailty.net Frailty.net is an international educational resource that aims to help geriatricians, primary care physicians and other health care professionals involved in the care of older persons implement frailty into clinical practice. http://www.frailty.net

Questions?

References Torpy, J.M. Lynm, C., & Glass, R.M. (2006). Frailty in older adults. Jama, 296, 18. Ko, F.C. (2011); Clinical Geriatrics in Medicine; 27(1):89-100 Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381:752-62. Ferrucci L, Gwen Windham B, Fried LP. Frailty in older persons. Genus 2005;LXI:39-53. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-56. Morley JE, Vellas B, Abellan van Kan G, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14:392-7. Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 2009;64:675-81. Subra J, Gillette-Guyonnet S, Cesari M, Oustric S, Vellas B. The integration of frailty into clinical practice: preliminary results from the Gérontopôle. J Nutr Health Aging 2012;16:714-20.